Tom Takubo

My whole reason for going into politics at all is that healthcare issues are tremendous in the state. And the fact is, I bet you 25% or more of the legislation that we deal—either directly or indirectly with—impact people's healthcare. And so I try to translate what I do in my day job over into that political sphere, and think to myself, “How can we make people's lives better?”

Aryana Misaghi

I'm Aryana Misaghi and this is Appalachian Care Chronicles, a podcast bringing you stories from every corner of West Virginia's health sector. Join me as we journey alongside a variety of problem solvers, change makers and daily helpers, who are all working behind the scenes and on the front lines to care for our communities. Together, we'll explore what they do day-to-day, the steps that got them there, and the why’s that continue to draw them back. How in the face of some of the most challenging situations possible, do they manage to keep themselves and the rest of us from falling apart? Far from predictable, the paths they've walked are full of twists and surprises, discovery and purpose. This podcast is for anyone who's ever even thought about going into the healthcare field or has a passion for caring for others in times of need.

Today, we're walking the halls of WVU Medicine's Thomas Memorial Hospital in South Charleston with Tom Takubo. He is a Pulmonary Critical Care Physician and also a State Senator and Majority Leader in the West Virginia Legislature. As a lung doctor, he specializes in the diagnosis and treatment of respiratory system diseases like asthma, chronic obstructive pulmonary disease, pneumonia, and lung cancer.

Tom Takubo

Yeah, so right now, I'm just doing a quick assessment. She's on the ventilator and sedated, so she can't talk to me, but I can listen to her lungs to make sure that she's moving good air back and forth. When you're on a ventilator and that breathing tube's in, your main airway bifurcates and a tube goes to the right lung and tube goes the left lung. So that breathing tube sometimes can slide too deep and go into one lung. So I want to make sure I'm hearing good breath sounds, and then feel the belly to make sure it's nice and soft, not hard and rigid, that something's going on. If you feel the feet, you'll see me look at feet a lot, if the feet’s nice and warm and pink, you know the circulation from the top to bottoms down. So people will get occlusions in their blood vessels, like in the main aorta, or sometimes you'll get what's called blood clots, or deep venous thrombosis in the legs, blocks off blood flow. So it lets you know things are going on. And a ventilated patient can't tell me that their legs hurting, or they can't tell me that their belly is hurting, and so you just kind of check all that. The other patient, you know, I'll take a quick look at pupils and stuff like that, to check sedation and make sure that that's reflexively okay. So the patients, even though sedated, can tell you a lot just by doing quick assessments.

Tom Takubo (to Patient)

Dr. Takubo, one of the lung critical care docs, to come and check on you. How are you feeling?

Patient (to Tom Takubo)

Pretty good.

Breathing okay, not any pain anywhere? Okay. Are they letting you eat? Have you ever been an A Fib before you have any heart trouble? High blood pressure?

Patient (to Tom Takubo)

Yeah.

Tom Takubo (to Patient)

Have you seen anything about getting you out of ICU? Okay, let's take a listen to you…

Tom Takubo

I deal with lung and ICU type work, so people that have all assortments of breathing problems, whether it be asthma or COPD or something called interstitial lung disease, black lung et cetera are just some examples. Those are mostly done outpatient to help folks manage. Of course, we do a lot of lung cancer and work those patients up and help define if, in fact, those nodules on their lungs are cancer or not, and get them to the right treatment.

And then we kind of flip hats and in the hospital, it's a little different, because here we're specialists in the ICU, and that's called an Intensivist, or an ICU specialist. We already do so much with the lungs and the ventilators and things like that. It has kind of become a natural fit. So the vast majority of critical care specialists are also lung doctors.

One of the things about critical care is we're kind of like the EMS within the hospital. So when somebody's because people will say, what's an Intensivist to do, or what's a critical care person do? It doesn't matter why you're in here, is it a heart problem, surgery problem, medical problem? When they get sick and their vital signs start getting unstable, they call us.

There's seven doctors in my group. We do four weeks in the office, three weeks in the hospital, because you obviously can't be seeing these really complex sick patients in the ICU. Plus, at any given second, I could get a call and I can have an emergency situation that I'm working on for hours, right? And so those weeks in the office are kind of like an eight to four day. This afternoon, I'll be making rounds all through the floors and then sitting back down the computer and going through all the labs and X-rays and cultures and medications and making those adjustments as needed to get people healthier and get them home. Tonight, for example, I'll be on call, so from 4pm tonight till 8am tomorrow morning, if something urgently is needed, I'll jump in the car and get to the bedside and help.

Aryana Misaghi

Dr. Takubo felt called to medicine from a young age, and his awareness of respiratory diseases specifically started when his father developed black lung disease after working for 40 years in the coal mines. In West Virginia, the job of a pulmonologist is never ending. Though, smoking rates generally have plummeted since the mid 1960s West Virginia has the highest rate in the country, with about a quarter of all adults in the state identifying as current smokers.

Tom Takubo

We also have an industry with a lot of that creates a lot of pneumoconiosis with coal miners. We also are in an area that is endemic to a fungus in the Ohio Mississippi Valley and West Virginians love to be out and they hunt and they fish and they hike, and when they step on those spores, and they get a fungus of their lung called histoplasmosis, and that creates these little nodules that can look identical to lung cancer. So when you add all that combined, it makes pulmonary medicine in West Virginia extremely busy.

Yeah, so I always migrated to critical care, because that was fascinating to me. I always felt and still do that if you can take care of the sickest of the sick, the rest of medicine becomes easy, right? So if you can take care of the most complex cases, then simple cases are simple. And when I was on surgery, I would watch the medicine teams go through and, you know, on surgery, you do more, but the medical teams kind of know more in terms of learning the intricacies of diseases and medications, etc. So I would always watch them and think, gosh, what am I missing? And same way, when I’d be on internal medicine rotations, I would look at the surgical teams, I’d think gosh, they're getting to do lots of stuff. And so pulmonary critical care is kind of a great fit, because you have to know a lot of the intricacies of the medicines. But at the same time, we do a lot of procedures and stuff too. For example, we put in central lines and do tracheostomies and bronchoscopies and lung biopsies and chest tubes and all kinds. It's really a blend of both.

Aryana Misaghi

This work sometimes requires a bit of advocacy. Dr. Takubo describes a dramatic interaction early in his career in which a teenager in foster care with significant psychiatric issues was repeatedly coming into the hospital with symptoms that caused her to be unnecessarily intubated. Over time, this caused severe scarring of the top of her windpipe. So doctors then made a surgical opening through her neck into the trachea and placed a tube there to help her breathe.

Tom Takubo

But then she got to where she would come in and purposely rip her tracheostomy tube out, and she'd have to be sedated again. And a lot of this, a lot of psychological trauma throughout her entire life, but was still ongoing. And so now the tracheostomy tube had caused scarring, and they could only get a small pediatric tube in, and she was now in the ICU on the ventilator. She had this pediatric tube in, and we were saying, what do we do? Because she just keeps doing this over and over and over. And the psychologist and psychiatrist had been consulted in and had worked with her for many, many months. She'd gone through extensive therapy, and the final diagnosis was, is that she had a terminal psychiatric illness, and we were instructed to take the tubes out and let her pass at 18 years old. I didn't feel comfortable with that. I consulted ENT. They refused to do the surgeries because everybody had deemed that this was, you know, she wasn't going to be compliant, she was going to harm herself even further with a new surgical wound. And so I was able to talk to some of my colleagues, and I was able to wake the patient up to where she was still on the ventilator, but conscious, and I told her, the state has made the determination that they're going to kill you. They're going to let you die. We're going to fix your windpipe, but you can't do this again, because they will not let us fix this again. And she understood. We re-sedated her. I was able to fix her windpipe myself, get a large trach in, and she never did it again a day after that. So we were able to get off the ventilator, and she's now in her late 30s. So that's one one that will always stick with me the rest of my life.

Vas Scouras (Production Crew Member)

Is she still one of your patients?

Tom Takubo

She is, and she's doing good, and she's got a child of her own. She seems very happy, and it's great to see on Facebook. She's very involved in her child's life, and does birthday parties and Christmases, and seems like everything's going great. I feel very blessed to be able to do what I'm doing, right? So I remember when I was in high school, my nightly prayers was “God, they may be smart enough to be a doctor and help people.” So he did, and that's one example where he let me, let me help.

Aryana Misaghi (Show Information Break)

Appalachian Care Chronicles is made possible thanks to the West Virginia Higher Education Policy Commission. West Virginia Invests is the state's tuition free community college program covering tuition and mandatory fees for certificate or associate's degrees in in demand fields, including nursing and other healthcare careers. Find out if you qualify and apply at collegeforwv.com. That's College For WV dot com.

Aryana Misaghi

Getting into politics wasn't a hard sell for his family, but his partners at the physician-owned Community Lung Center he founded years ago wondered how he'd managed to do both.

Tom Takubo

Pulmonary critical care is extremely busy, and their question is, “What the heck are you going to do when you're over at the Capitol and we've got ICUs and offices and people needing procedures and etc?” But they've been wonderful. They've been and as time's gone on, they've got more and more supportive, and they've seen it firsthand. They've seen what I've been able to be part of and help with. No one person does anything by themselves, but I've been able to kind of lead the effort on a lot of things that have been very beneficial to healthcare. And they've seen that they appreciate a lot more than, than they did.

Aryana Misaghi

It was a personal invitation to the State of the State address that led to Dr. Takubo’s career in the legislature. The daughter of one of his lung cancer patients was a member of the House of Delegates, and she wanted to thank him for taking care of her mother. Dr. Takubo’s own 10 year old daughter was especially interested in politics, so he accepted the invitation, and both of them watched from the gallery.

Tom Takubo

And I made a comment that, “Wow, there's a lot of people making decisions that I really wouldn't want, making decisions for me.” That somehow, and to this day, I don't know how, but that got out to a gentleman who then contacted me and says, “I’d like to take you to dinner,” and he was the State Party Chairman, and I thought he wanted a donation, but what he really did was laid out a whole schematic in front of me as to why it would be so important for West Virginia to have a physician in the legislature. And I had zero interest or idea of even thinking about being the legislature, but he showed how the state was changing, how it was about to flip Republican, and most importantly, though, there's so many health care things that goes on, and these guys have to make a decision. They can't just not take a vote because they're not in the medical profession. They have to, and what it would mean to the state, and it made sense to me, and I had always wanted to do public service, and I thought, “Well, I'll throw my name in the hat, and if it's meant to be, it's meant to be, if it's not, that's okay.” But apparently it was.

Aryana Misaghi

Dr. Takubo is one of four physicians in the West Virginia Legislature at an important time when healthcare misinformation is widespread and when on the ground experience of physicians who are treating patients and seeing healthcare trends in the population help inform policy discussions and decisions.

Senate President

Senior Senator from the 17th…

Tom Takubo

Thank you, Mr. President, it is Nursing Day here at the Capitol, and if all the nurses wouldn't mind standing and let the Senate give you a very big thank you for all that you do for each of us all year round.

Senate President

Are there further introductions?

Senate Clerk

Senate Resolution 30, designating February 8, 2024 as West Virginia Hospital Day at the Legislature.

Senate President

Question is on adoption of Resolution. Is there a discussion? Senior Senator from the 17th…,

Tom Takubo

Thank you Mr. President, today is Hospital Day at the Legislature, and we have with us visiting hospital representatives and healthcare workers from across the entire state. Hospitals play such a critical role in improving the health of our citizens. Last year, West Virginia hospitals treated over 7 million people in our state in their outpatient departments, they provided emergency care to almost 900,000 people. Hospitals also play an important role in our economy, employing nearly 53,000 people and contributing 12.5 billion annually to the state's economy. And I believe, behind state government, they're the largest employer. Hospitals are an important part of our educational system, with instructional programs that provide a wide range of services for both technical and professional positions. They do a lot for us. We want to say thank you. And I urge adoption.

Senate President

Is there further discussion? If not, the question is adoption of resolution. All those in favor say, aye.

Senators

Aye.

Senate President

Those opposed, no. Ayes appear to have it. The ayes do have it, I declare the resolution adopted. Bills on third reading.

Senate Clerk

There are none.

Senate Presient

Bills on second reading…

Tom Takubo

Whether it's healthcare issues, or economic issues, whatever, but everybody gets an equal vote and elections matter. Problem is, oftentimes they'll come in with predetermined ideas, and there's not great foundation for it, because they garnered it off of social media. All you can do is try to educate and re-educate and re-educate, but ultimately, everybody's vote counts the same.

I'm still in awe every day when you make that walk into the Capitol, we've got one of the most beautiful capitals in the world, and just to know that I've got the privilege of being able to walk in there and be in the voice for roughly about 105,000 people that you know, I don't I don't take that lightly. Thirty-four senators in West Virginia and one hundred delegates. Every single one of those I truly believe, in their heart of hearts, wants to make this a better place. Now we may have different views on the pathway to get there. The thing that makes it tough is that the process changes over the 60 days. So day one is extremely different than day 60. By six weeks, you're now approaching crossover day. You're approaching other deadlines. Things have to get over to the House. Now you're receiving all this stuff from the House into the Senate, and then you're done for 10 months. And when I say done, you're never done. It's a daily job, but you're not in session anymore. And so that that 60 day legislative session, it takes a few years to really understand what the heck you're really doing.

I don't know if it's a surprise, or it's somewhat heartbreaking, because I've seen people come in with really good intentions and holding that political office becomes more important to them than why they sought that political office in the first place. And I've seen people that I know their hearts are in one direction, but they act in another direction because interest groups are really pressuring them, and it's going to mean whether or not you get reelected or not, or they, at least they feel that right. And for me, it's a really difficult thing to become a physician, you know, being a politician does not define me in the least, being a politician is something that I feel very fortunate to be able to make the sacrifice to do, because I think it's helping people. At least I hope I'm helping people. But that doesn't define me, if I get voted out tomorrow, so be it. You know, I've got a pretty important job that I care about every day. I'm not going to jeopardize what I know is right, what I believe in, because I think that's going to be important to me getting reelected. I mean, if it gets to that point, then I shouldn't be in the office anymore.

Come January, there's only going to be maybe one or two senators that has been there longer than me. But through those 10 years, I've seen some people that I really admired and worked hard on behalf of people that I've seen change. And that's been the most heart wrenching thing I've seen in politics.

Aryana Misaghi

Dr. Takubo was born in Columbus, Ohio, and moved to Logan County, West Virginia, when he was three years old, he graduated from Marshall University and went to medical school at the West Virginia School of Osteopathic Medicine in Lewisburg. He completed a fellowship program in Tennessee, and they urged him to stay there, but he was drawn back to what he feels is home.

Tom Takubo

There's just something special about West Virginia. And you know, I grew up here around the hills and mountains and doing like every other typical West Virginian, and it's just one of those things where I tell people all the time, you've got to have two families, right? When you're in medicine—true for most professions, but you've got your work family and you've got your actual home family—and unfortunately, especially in medicine, sometimes you end up spending more time with your work family than you do your home family, or almost equal time, sometimes.

When I finished up, I was coming back to West Virginia and going to buy a house, and they asked, how many years of education? And I said, what do you mean College? Or they said, No, total. I said, since grade school? And he said, Yeah. And I said, 28. And they laughed. Now, what I tell kids, they think, oh my gosh, that sounds like a lot of school, but the reality is, med school is a lot of fun. Now it's the equivalent of taking 30 college hours or more semester, 30 to 35. You're constantly learning about things that you've seen or heard of, didn't understand, or and it's just an amazing thing that you do as you go through the pathway of medicine. And so, yeah, it's a lot of work, but it's fun stuff to be learning. It's not like you're learning calculus or stuff that you don't figure you're ever going to use again in your life. But I mean, even as a medical student, you'll have family and friends saying, Well, how does this work? And you're able to explain it to them, explain it to them, right? And that's, that's, that's fun.

Aryana Misaghi

Dr. Takubo has been trying to advance a bill that would give West Virginian physicians just coming out of residency or fellowship a five year state income tax waiver if they agree to come back home to work. Other states have tried similar programs.

Tom Takubo

You say, “Oh my gosh. You know, doctors make higher incomes. Why would you do that?” Well, doctors are coming out oftentimes with average of three to $400,000 in debt, just from student loans, because medical school's so crazy expensive. The thought process is, once they've been here for four or five years, they've established a practice, high likelihood they've got a home, they've got a family, that they're not going to leave and if they don't come in the first place, we're not getting any state income tax anyway, right? We've got to figure something out to get these people to help encourage them and entice them to stay home.

Aryana Misaghi

Medicine is rapidly advancing, just like any other technology. We've gotten used to some of these new advancements really quickly, like telehealth and online patient portals, but concepts like artificial intelligence are making their way into hospital quarters and patients' homes as we speak, and these changes are really exciting.

Tom Takubo

The healthcare disparities are not going to be solved with people alone, and one of the things you know—throwing my political hat and my medical hat on the same time—is we're working with folks to try to help solve problems. More recently, LG Nova has signed a deal with West Virginia. We've worked with Amazon. We're working with Microsoft and other vendors. You know, one of the problems West Virginia has, we're rural, we're poor, we're remote, we don't have great internet access, we've got horrid rates of obesity and diabetes, we're the number one smoking rate in the country—and so one of the things we're working on is, how do we do that using simple smartphone and AI, that can be as simple as doing things where your medication box is Bluetooth, and maybe you grant that access to another provider where if you know grandmother's not taking their medications, there's reminders across the TV or their phone to do that, and so that compliance alone can help keep people healthy and out of the hospital. It can also trigger family members, “hey, they're not taking their medication,” so they can call and check on them. Or you can do more complex, so for example, if you've got a patient that's not feeling well, they can go to their app on their phone and start answering questions. But because it watches your medical history, it can start creating a differential of what may be wrong with you. And so, for example, it may say, “Check your blood sugar.” Well, you go check your blood sugar. But the glucometer is Bluetooth to your phone. It watches you take your insulin every day, and it knows and understands what your insulin resistance is, how you respond to insulin. It may even be your blood sugar's 800 so the AI is able to say, “Here's how much insulin you take.” So it takes it says, “Recheck your blood sugar in an hour.” So you do that. Hour later, you're feeling a little better, so you forget. But across your TV, your cell phone starts chirping, hey, you got to recheck your blood sugar. Oh, I forgot. Go check it. It's still 600 it again, tells you what dose to take. By the end of the night, you're corrected. That patient today ends up going to the hospital. They're admitted for several days, huge health care costs, both for the patient and the system for that. AI on your phone can do a lot of this.

Aryana Misaghi

If you find that a little hard to wrap your mind around, you're not alone, and this is all speculative still. Dr. Takubo imagines a time in the future when he will use his medical expertise and experience to help guide legislation concerning these changes.

Tom Takubo (to Patient)

You can certainly be as busy as you want to be. You know, medicine is changing. There's lots of opportunities, but you can control a lot yourself. Some places, it's more when you get a more competitive market. It's a little bit of a dog fight about trying to get patients. That's not the case here in West Virginia. The other thing I would say is, it's just an amazing place in how appreciative patients are. I mean, it's more than just, “Hey, thanks, doc.” They really appreciate you. And when I’m out and about just having dinner, walking through Sam's, or Target, and my kids have seen it time after time after time of patients just being so appreciative for the work you do for them. And that's something you're not going to see everywhere. No doctors are starving. Paychecks, good. Obviously, you go through a lot of schooling, and they deserve what they make, but there's nothing that replaces the satisfaction that you've been able to help somebody on the level that very few people were able to do.

Aryana Misaghi

Appalachian Care Chronicles is a production of the West Virginia Higher Education Policy Commission, Health Sciences Division, which is solely responsible for its content. Guest opinions are their own.

Special thanks to WVU Medicine Thomas Hospitals.

For more information about educational opportunities related to healthcare in West Virginia, visit appcarepod.com that's A PP Care Pod dot com.

I'm Aryana Misaghi and you’ve been listening to Appalachian Care Chronicles.

On the next episode, we'll be exploring what it's like to work with one of Medicine's most powerful tools, an MRI machine. Sally Adams, an MRI tech with decades of experience under her belt, walks us through the incredible innovations and the unique challenges that come with giant magnets!

That's next time on the Appalachian Care Chronicles. Thanks for listening!